As the recession lingers, the pressure on the NHS to undergo major reforms to improve its efficiency and cost-effectiveness continues to mount. This environment is what Alan Payne, CEO of Healthsolve, refers to as ‘the perfect storm’ – a storm out of which InHealthcare has emerged as an innovative solution to help lighten the NHS’s burden while at the same time improving patient care.
Healthsolve is a specialist IT company which builds and supports custom-developed healthcare solutions. In 2012, Yorkshire-based managed services provider InTechnology made a strategic investment in Healthsolve, and InHealthcare was born. InHealthcare is the UK’s first end-to-end managed telehealth service designed to help patients self-manage long-term conditions such as diabetes, chronic obstructive pulmonary disease (COPD), chronic heart failure and stroke.
Struggling to grasp just what this entails? Well, let’s set the scene.
Telehealth is the delivery of health-related services via information and communication technologies. Take John. He’s been diagnosed with high blood pressure, which puts him at risk of numerous potentially serious conditions, including stroke. He needs regular monitoring, but with telehealth, he doesn’t need to travel to his local hospital or GP; instead, he can check his blood pressure at home. When he’s done this, the telehealth device transmits the data to the clinician, who checks the data. If everything is as it should be, that’s fine. If the results are abnormal, the clinician will call John and have him take the test again – still at home – if the results are still abnormal, appropriate action can be taken. In the meantime, all John’s medical data is recorded on the InHealthcare database, where it is monitored and analysed. (And if John forgets to check his blood pressure, an alert will be generated and he will receive a phone call to remind him to do so!) This is an example of telehealth in action at a simple level.
Central to InHealthcare’s approach is triage. Originally developed by French doctors on the battlefields of WWI, triage is the process of determining the priority of patients’ treatment based on the severity of their condition. This includes managing resources; for example, emergency treatment and the order and priority of emergency transport. Triage can manage hospital admissions and visits to A&E departments and GP practices more efficiently, in the process make patient care more effective.
If a patient is able to live independently, in their own home, while still having their health closely monitored, it’s better for everyone. Moreover, the ability to track and record a patient’s health and have that on file allows medical practitioners to make pre-emptive decisions if they see someone’s risk levels rise.
InHealthcare offers more advanced options for people who need more comprehensive, specialist care too, while a system that can help a clinician intervene and stop an incident from occurring presents an enormous cost-saving opportunity. Payne explains, “Our fully managed service removes the worry for both GP and patient about how to implement it. We work with the customer to understand their requirements. Then, using open-source software we create a patient-focused solution based around their specific needs.
“At one end of the spectrum, the highest end with the most care required, there are people with multiple conditions (asthma, chronic obstructive pulmonary disease (COPD), heart conditions or diabetes). This might involve having to take 15 different measurements or tests regularly. We can cope with this – all the data gets recorded into a clinical grade health record, NHS standard, and then moves to triage.”
“At the other end of the spectrum,” Payne continues, “we have what we call Telehealth Direct, which is a very simple telephone system. Again we begin with creating the protocol – so, for example, if it’s medicine for blood thinning that the patient has to take every day, we’ll read out a script which has been typed into a computer and they will get a response back based on the input combined with what’s contained in their health records, make another determination and ask another question. And so it goes until we get through the entire medical protocol just as if the patient was in their doctor’s treatment room.”
Saneth Wijayaratna, CEO of InHealthcare, points out that the data collected by InHealthcare could also have a positive impact on courses of treatment. “By building a map of the progress of patients with a particular condition or using a specific medicine, they can see how effective it is as well as create predictive trends to see if someone’s recovery is as it should be. In essence, this data can be used like medical trails on a massive scale”, he says, adding that “this data is not shared with third parties or pharmaceutical companies, and patient confidentiality remains paramount.”
In terms of the technology, InHealthcare delivers the entire stack in this technological solution, from the box used to measure various health conditions to the web-based management for accessing and recording patient data, through to the storage and management of all the data collected during the service. This is where cloud computing comes in – the entire range of InHealthcare’s managed services is delivered via InTechnology’s enterprise-grade cloud infrastructure and the company’s own data centre.
Payne explains: “The whole purpose of buying a fully managed service like this is that it removes obstacles. A few years ago, basic telehealth-type systems involved using the patient’s telephone line for dial-up Internet; today we install a SIM card inside the actual device or we call the patient – and even if they call us, we still pay for the phone call! There’s no cost to the consumer whatsoever. We can also provide Internet lines and take responsibility for creating the system for the medical teams to use. We give them logins, but the capturing and storing of the data is all managed by InHealthcare.”
Wijayaratna explains that Healthsolve has developed a platform based on open standards architecture, “which makes it a lot easier to integrate. The customisable, human-first features of InHealthcare’s services are of utmost importance to us.”
Nevertheless, one of the main selling points of the telehealth and eheath services is that they have the potential to provide the NHS with some much-needed cost-cutting solutions. Consider that fact that the biggest reason for re-admittance following treatment is patients not taking their medication properly. “I’ll give you an example” says Payne. “You leave hospital following eye surgery and get your dosage instructions written up as part of your discharge certificate. You may be given five days’ worth of eye drops, as well as medication or pain killers. However, because there areso many instructions and they’re written on a label that’s two inches in size, the irony is probably not lost on many people that you’ve just had eye surgery and you’ve been given instructions in a tiny font!
“What we can do is call you and read the text to you, at the time you’re supposed to take it and receive feedback as to whether or not you’ve taken your prescribed treatment. We think this will radically improve something as simple as re-admission which could in turn save the NHS huge amounts of money.”
Wijayaratna is keen to point out that while the technology is important, the focus for telehealth should not be on the technology but about what the end-to-end service ultimately means for patients. There is undeniably money to be made in a sector which needs to evolve in the face of enormous, ongoing financial pressures, but the desire to deliver a service designed to improve the delivery of healthcare is the driver for both Wijayaratna and Payne.
Wijayaratna concludes: “What we’re seeing is that our infrastructure helps clinicians to manage patients remotely, better, and enables them to capture data more effectively and more accurately. This in turn improves decision-making. Ultimately, it means improved healthcare. The NHS is something to be hugely proud of in the UK and I am passionate about potentially being able to look back and say we saw the challenges that faced the NHS and we were part of helping the NHS reshape itself.”